Traumatic cervical-level spinal cord injury can result in permanent and extensive paralysis below the level of injury, causing the loss of multiple body functions, including hand, trunk and leg movement, bladder and bowel control, and respiratory capacity. The goal of this project is to restore these multiple functions to these individuals through a comprehensive neuroprosthetic approach that addresses the overall needs of the individual. This approach involves all aspects of the implementation, including the implanted technology, the surgical installation, and the outcomes assessment through a coordinated team approach in order to maximize the functional independence gained by the individual. With this system, we intend to provide individuals who have a mid-cervical level spinal cord injury with control over grasp, reach, cough, turning in bed, seated posture, and bladder function. This ambitious and exciting goal is made possible by the culmination of our research and clinical deployment of neuroprosthetic systems for spinal cord injured subjects over the past 30 years and our development of an advanced neuroprosthesis. We anticipate that this system will not only provide increased independence in each of the targeted body functions, but will provide an overall benefit to demonstrate significant improvements in quality of life and health outcomes. In clinical feasibility studies with spinal cord injured subjects, our clinical research teams have demonstrated the control of bilateral hand function, rolling and postural control, cough, bladder control and bowel control using chronically implanted neuroprostheses. Outcomes from each clinical study demonstrate that each system provides increased functional independence to the individual. However, to this point, it has not been possible to address each individual's holistic needs and tailor an overall approach that maximizes the function gained. Through the development of a Networked Neuroprosthetic System (NNPS), we now have the technological foundation for a multi-functional system. The strategy employed in this U01 project is to finalize the key components of our proposed holistic neuroprosthetic approach. Thus, each component of the approach, including the technology, regulatory approvals, surgical installation, outcome assessment and overall implementation, will be brought to completion during this project, culminating in the implementation of the multi-function NNPS in spinal cord injured subjects. The ultimate outcome of this project is that we will demonstrate the feasibility of addressing multiple disabilities in severely disabled individuals using an advanced neuroprosthetic system coupled with a streamlined and cohesive implementation strategy. PUBLIC HEALTH RELEVANCE The impact on the health of disabled individuals of our proposed multi-function neuroprosthesis is signficant. Individuals with cervical-level spinal cord injury should be able to regain the use of the hands for grasp and reaching, regain seating stability, regain the ability to roll over in bed, regain the ability to generate a productive cough, regain bladder function and regain bowel function.